Forensic Evaluation of Refugees from Myanmar

Social Science & Medicine, 1991

There are pitfalls in the singular application of western categories in diagnosing psychiatric disorders and distress among refugees Based on my research with Cambodian refugees I argue that cultural bereavement. by mapping the subjective experience of refugees, gives meaning to the refugee's. distress. clarifies the 'structure' of the person's reactions to loss. frames psychiatric disorder in some refugees, and complements the psychiatric diagnostic categories: Cultural bereavement includes uhf refugees' picture-what the trauma meant to them; their cultural recipes for signalling their distress; and. their cultural strategies for overcoming it-and the cultural interpretation of symptoms commonly found among refugees that resemble post-traumatic stress disorder. Cultural bereavement may identify those people who have post-traumatic stress disorder on the Diagnostic and Statistical Manuai (DSM) criteria but whose 'condition' is a sign of normal. even constructive. rehabilitation from devastatingly traumatic experiences. Cultural bereavement should be given appropriate status in the nosology.

International Migration, 2013

Social Science & Medicine, 2004

In June 2001, we assessed mental health problems among Karenni refugees residing in camps in Mae Hong Son, Thailand, to determine the prevalence of mental illness, identify risk factors, and develop a culturally appropriate intervention program. A systematic random sample was used with stratification for the three camps; 495 people aged 15 years or older from 317 households participated. We constructed a questionnaire that included demographic characteristics, culture-specific symptoms of mental illness, the Hopkins Symptoms Checklist-25, the Harvard Trauma Questionnaire, and selected questions from the SF-36 Health Survey. Mental health outcome scores indicated elevated levels of depression and anxiety symptoms; post-traumatic stress disorder (PTSD) scores were comparable to scores in other communities affected by war and persecution. Psychosocial risk factors for poorer mental health and social functioning outcomes were insufficient food, higher number of trauma events, previous mental illness, and landmine injuries. Modifications in refugee policy may improve social functioning, and innovative mental health and psychosocial programs need to be implemented, monitored, and evaluated for efficacy. Published by Elsevier Ltd.

Australian and New Zealand Journal of Psychiatry, 2011

The Psychiatric clinics of North America, 2012

This article adds to the existing literature on the role of mental health professionals in assisting attorneys in the asylum and refugee determination process primarily in the United States. The authors describe the legal context for asylum and refugee processing, challenges in conducting evaluations, diagnostic considerations, and specific competencies needed for mental health evaluators. Various cases are presented to illustrate key points. These cases purposely do not include any identifying information of any specific client, yet they are representative of the range and scope of issues that arise in this context.

Journal of Community Psychology, 1994

This study examined possible differentiating experiences between Post-Traumatic Stress Disorder (PTSD) and non-PTSD refugees, after matching them on certain demographic characteristics and exposure to trauma. Previous research on predictors of PTSD usually has not controlled for differences in trauma exposure between the comparison groups. By examining individuals who have had similar traumatic histories, this study more clearly identified some factors implicated in the development of PTSD among Southeast Asians. To increase-comparability with previous PTSD research, aU events were assessed with reference to three time frames involving premigration, migration, and postmigration periods. The role of anger reactions was also examined in view of previous findings from the veteranbased PTSD research. Finally, this study ascertained the influence of acculturation and cultural identity orientation because these variables often have been implicated in the adjustment of Asian Americans. Results from the present study indicate that respondents with PTSD appeared to experience and express much more anger and were more dependent on public assistance. They were also less engaged in maintaining their cultural traditions and ties. However, more life changes and a trend toward more separations and reunifications with family members were evidenced for those without PTSD. The implications of these findings in developing community intervention strategies for Southeast Asian refugees who have experienced trauma are discussed. Both community and clinical studies indicate that many Southeast Asian refugees have experienced serious and prolonged trauma as a result of the mass exodus from their homelands during and following the Vietnam War (Gong-Guy, 1986; Kinzie et al., 1990; Mollica, Wyshak, & Lavelle, 1987). Traumatic experiences reported to mental health professionals by Cambodian refugees, for instance, have included forced labor, wandering in the jungle for years, witnessing execution of family members, and death of family members due to starvation, torture, or illness (Kinzie, Fredrickson, Ben, Fleck, & Karls, 1984). Other trauma commonly experienced by refugees include painful separations from spouses, ~hildren, and parents whose fate remains unknown, as well as the violence, crowding, and unsanitary conditions common in many refugee camps.

International Forum of Psychoanalysis, 2009

That persons who are objects of violence and traumatisation become offenders themselves is a typical feature of ill-fated cycles of violence in countries torn by fierce political, ethnic, and religious conflicts. Some refugees and migrants with this background present a challenge to forensic psychotherapy when they continue such patterns of physical force and criminal behaviour in a host country like Germany, and are found to be either not responsible or of diminished responsibility for their criminal acts by reason of mental disorders or addictions. Their offences create a critical legal situation for them, since they are threatened with deportation. At the same time, their clinical condition is critical, for they were possibly subjected to traumatic experiences by authorities in their past; their cooperation in the treatment can seriously affect their legal status. Finding a way out of these complications has to take these special factors into account. Our paper focuses on the case study of a refugee from North Africa, illustrating a model of cooperation in forensic inpatient treatment, special trauma therapy (narrative exposure therapy), and expert testimony.

The journal of the American Academy of Psychiatry and the Law, 2010

Individuals fleeing persecution have the right to asylum. This most fundamental right was guaranteed by the 1951 United Nations (UN) Convention Relating to the Status of Refugees and was implemented in the 1967 UN protocol regarding refugee status. The United States codified refugee protection and the procedures for asylum in the Refugee Act of 1980, which was made part of the Immigration and Nationality Act (INA). In claiming refugee status, the burden of proof rests with the asylum seeker and is often a daunting task, given language and cultural barriers, lack of knowledge about U.S. legal procedures, and the reality that oppressive states do not document their intentions to persecute dissidents. Forensic psychiatrists may be asked to provide mental health assessment in immigration cases. In this article, an example of a Central American man with a nontraditional but increasingly common request for asylum is presented, the asylum process is described, and the role of the forensic ...

International Journal of Mental Health Systems, 2015

Background: Researchers and practitioners are concerned with a range of inter-related factors that impact on the mental health of refugees, including the traumatic events (TEs) of conflict, conditions of post-migration adversity, and the broader psychosocial disruptions that these societies have experienced. In addition, there is growing recognition that refugees are at risk of a wide range of common mental disorders that include but extend beyond the commonly studied category of post-traumatic stress disorder (PTSD). There is a need therefore to establish an integrated and comprehensive package of measures to assess all elements of relevance to the mental health of refugees. This report describes the rationale, design, development and first stage testing of the four modules (TEs, ongoing adversity, psychosocial impacts, and mental disorder categories/reactions) of the Refugee Mental Health Assessment Package (R-MHAP), drawing on data from a survey of West Papuan refugees (n = 230) residing in Port Moresby, Papua New Guinea. We detail the sequence of qualitative (based on informant interviews, focus groups) and psychometric tests undertaken in the development of the four modules. Results: Preliminary modules were adapted according to our qualitative findings. Psychometric testing of the relevant modules yielded coherent factorial structures and demonstrated sound convergent and discriminant validity. For TEs, the factors comprised conflict-related experiences, traumatic losses, witnessing murder, childhood adversities, and health stress; for ongoing adversity, factors included deprivation of basic needs, difficulties accessing health care/health problems, displacement, and conditions of safety in the community; and for psychosocial impacts, factors included threats to safety; ruptured relationships; injustice related to past human rights violations; challenges to identity; and existential meaning (related to expression of political aspirations). There was strong agreement in assignment of cases of mental disorder (as a composite grouping) between the R-MHAP administered by field workers and structured clinical interview conducted blind by a psychologist. Symptom means for the majority of diagnostic categories remained stable over a 6-month period. Conclusions: Our first-stage assessment suggests that the R-MHAP holds promise as a comprehensive assessment package for use in the refugee mental health field.

Australian and New Zealand Journal of Psychiatry, 2012

The present study seeks to examine the impact of therapeutic interventions for people from refugee backgrounds within a naturalistic setting.